In 2004 a change in Germany’s health insurance law allowed the country’s statutory health insurers to participate in integrated care projects. Most programmes focused on managing care for specific conditions or procedures. But the Gesundes Kinzigtal Integrated Care programme set its sights on co-ordinating care for an entire population – the Kinzig valley.
The programme is run by Gesundes Kinzigtal GmbH, a regional integrated care management company, which is owned jointly by the local physicians’ network and OptiMedis AG, a German healthcare management company, notes Helmut Hildebrandt, CEO of Gesundes Kinzigtal and head of OptiMedis. Two insurers participate in the programme, and Gesundes Kinzigtal is in charge of the healthcare budget for the 31,000 enrolees.
The philosophy is that improving health through preventive programmes and care coordination will save money. As an incentive for providers, profits are shared between Gesundes Kinzigtal and the insurers.
Mr Hildebrandt and others describe some of the project’s techniques in a recent journal article published in June 2010:
- Individual treatment plans with goal-setting agreements between patients at risk for certain diseases and their doctors.
- Patient self-management and shared decision-making between patients with chronic illnesses and their doctors.
- Follow-up care and case management after patients are discharged from the hospital.
Hospitals and other providers facilitate co-operation through jointly developed care plans or “pathways” (structured, multidisciplinary plans of care for specific diseases or conditions) and synchronisation of medications and electronic patient records.
Gesundes Kinzigtal targets particular health problems among the population it serves. For example, it has launched programmes to encourage elderly patients to exercise and to manage the care of patients with chronic heart failure.
The results since July 2006 have been promising, Mr Hildebrandt says. For example, heart failure patients in Gesundes Kinzigtal receive their medications 100% of the time, compared with 94% for the overall region. Their age-adjusted mortality rate shrank from 5.95% to 2.04% in the programme’s first two years. Meanwhile, the programme saved €1.9m in 2007 (most recent available data).
Gesundes Kinzigtal Integrated Care is succeeding in substantially improving the population’s health and generating significant savings compared with standard care in the region. If the programme and others like it succeed, they “might develop into a role model for large parts of the German health service system”, according to the journal authors.
